STAR+PLUS MMP Prior Authorization

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DISCLAIMER:

All attempts are made to provide the most current information on the Pre-Auth Needed Tool. However, this does NOT guarantee payment. Payment of claims is dependent on eligibility, covered benefits, provider contracts, correct coding and billing practices. For specific details, please refer to the Medicare Advantage provider manual. If you are uncertain that prior authorization is needed, please submit a request for an accurate response.

Complex imaging, CT, PET, MRA, MRI, and high tech radiology procedures need to be authorized by NIA
Behavioral Health/Substance Abuse need to be verified by Cenpatico 
(Effective November 1, 2017, prior authorization for behavioral health will transition to Superior HealthPlan.) 

 

Non-participating providers must submit Prior Authorization (Inpatient Form | Outpatient Form) for all services
For non-participating providers, Join Our Network

 

Are Services being performed in the Emergency Department, or Urgent Care Center, or are the services for dialysis or Hospice?

Types of Services YES NO
Is a non-par provider rendering services other than lab, radiology or flu or pneumonia shots?
Is the member being admitted to an inpatient facility?
Are anesthesia services being requested for pain management, dental surgery or services in the office rendered by a non-participating provider?
Are services other than lab, radiology, domiclliary visits or DME being rendered in the home?